EDITORIAL

How to measure success?

Standards of excellence, outcome measures, statisticallysigni®cant, ¼ are some of the terms used to judge theend result of orthodontic treatment. Are these measuresappropriate to judge the orthodontic end result? Onecould argue they may not be.

Standards of care were developed long time ago, sothat orthodontics would resemble the rest of medicine.There would be rules, values to attain, and the resultwould last for a while. In medicine these are still prac-tised. For example, it is good to lower the patient'ssystolic and diastolic blood pressure to an exacting set ofnumbers, just as it is good to lower the triglyceride levelsin the blood. This might be good medicine. But howdoes the plastic surgeon decide what the size of a breastimplant or the width of a chin implant, or the thicknessof the lips ought to be? Obviously, the surgeon doesn't.After the patient is offered several choices, the outcomeof the subsequent dialogue between the plastic surgeonand the patient is the treatment plan. In this scenario, itis the patient's happiness that is important. Why not inorthodontics?

Clearly, neither plastic surgery, nor orthodontics dealwith life-threatening conditions. We do what we dowell, and if the patient is happy, that is the end of it.Why then are we so involved in making everyone lookthe same? Depending upon the prevailing winds offashion within the specialty, in the hands of the clinicianpatients either have second and third molars coming outof their ears upon smiling, or all the front teeth aretipped back. There is something wrong.

Often, listening to one speaker all-day in a hotelroom is considered education or training. Some ofthese speakers are simply devoid of credentials, and theothers give their lectures without being accredited.Caveat emptor. Unfortunately, these speakers do not

necessarily teach what is known, but speak what theaudience wants to hear. Orthodontic education andtraining cannot be found in weekend courses. Instead,they should be taken as a suitable forum for clinicianswho attend to exchange ideas.

In these continuing education courses what we typic-ally see is their way to do things as the only way. Thesedogmatic standards are not questioned, perhaps, becausethe specialty ®nds security in standards. This may verywell be wrong. It might be better to use patient's level ofsatisfaction as the measure of orthodontic success.

Criteria used for board certi®cation in many countriesaround the globe are not necessarily conducive tohealth. It is not shown that intercuspation one way, orthe other is better for health. Practitioners of ortho-dontics would agree that a functional, but not ideal,intercuspation can be achieved with superior estheticresults, while it is also possible to create the exactopposite, poor esthetics with a textbook intercuspationof teeth. Most likely, if a practitioner has a case whereexcellent esthetics was achieved, but not a textbookocclusion, he/she will never present this result to theBoard of Examiners for certi®cation. This particularcase may be one of his/her most successful cases, but theBoard would not think so.

Time might have come to think more qualitativelythan quantitatively. It is hard to de®ne beauty with anexacting yardstick.

Throughout their history, Italians are known to pos-sess the highest level of appreciation for art, design,proportions and beauty. Members of SIDO perhapsshould take on the challenge to de®ne beauty for the restof the orthodontic world.

Orhan C. TuncayEditor

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